The impact of variations in care and complications within a colorectal enhanced recovery after surgery (ERAS) program on length of stay
| Autor: | Alex Limmer, James Rogers, Toufic El Khoury, Grahame Ctercteko, James Wei Tatt Toh, Angelina Di Re, Jack Cecire, Tom Liang, Fiona Lee Gavegan, Edgardo Solis, Karen Shedden, Annelise Cocco, Kerry Hitos, Nimalan Pathma-Nathan, Kar Yin Fok |
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| Rok vydání: | 2020 |
| Předmět: |
Laparoscopic surgery
medicine.medical_specialty Multivariate analysis Ileus business.industry medicine.medical_treatment General surgery Gastroenterology Psychological intervention Anastomosis medicine.disease Colorectal surgery Discontinuation medicine Surgery business Enhanced recovery after surgery |
| Zdroj: | Annals of coloproctology. |
| ISSN: | 2287-9714 |
| Popis: | Purpose: Enhanced Recovery After Surgery (ERAS) has become standard of care in colorectal surgery. However, there is not a universally accepted colorectal ERAS protocol and significant variations in care exist between institutions. The aim of this study was to examine the impact of variations in ERAS interventions and complications on length of stay (LOS).Methods: This study was a single-center review of the first 200 consecutive patients recruited into our prospectively collected ERAS database. The primary outcome of this study was to examine the rate of compliance to ERAS interventions and the impact of these interventions on LOS. The secondary outcome was to assess the impact of complications (anastomotic leak, ileus, and surgical site infections) on LOS. ERAS interventions, rate of adherence, LOS, readmissions, morbidity, and mortality were recorded, and statistical analysis was performed.Results: ERAS variations and complications significantly influenced patient LOS on both univariate and multivariate analysis. ERAS interventions identified as the most important strategies in reducing LOS included laparoscopic surgery, mobilization twice daily postoperative day (POD) 0 to 1, discontinuation of intravenous fluids on POD 0 to 1, upgrading to solid diet by POD 0 to 2, removal of indwelling catheter by POD 0 to 2, avoiding nasogastric tube reinsertion and removing drains early. Both major and minor complications increased LOS. Anastomotic leak and ileus were associated with the greatest increase in LOS.Conclusion: Seven high-yield ERAS interventions reduced LOS. Major and minor complications increased LOS. Reducing variations in care and complications can improve outcomes following colorectal surgery. |
| Databáze: | OpenAIRE |
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